如何看血常规检查结果

如何看血常规检查结果 绝大多数咨询的都不是学医的，不会看血常规结果可以理解，甚至即使是学医的，如果不是血液科的，不少医生也不太会看。但是血常规又是一个很基本的常规检查，凡是来咨询的几乎多少都会涉及血常规结果的疑问。所以很有必要在这里介绍一下如何看血常规，当然主要是结合血液病病人的特点，有些指标的意义不会全面解释。 现在的血常规基本上都是血细胞自动分析仪分析的结果，受仪器本身的因素、血样标本抽取是否合适(是否很顺利或者是否抽取了标本发生血凝或是否因为种种原因标本为乳糜血)、检测人员的操作是否得当、检验科质量控制是否做得好以及外界因素(譬如抽取标本时的情绪、环境温度等)等因素的影响，难免会有差错发生。所以，如果检查结果提示有某项指标明显异常，但是又好像和临床现象不太符合时，需要考虑到检查差错的可能，尽管发生几率不是很高，必要时需要重复检查，譬如说如果临床没有贫血的症状，但是检查结果提示有明显的贫血，或者如果是临床没有出血 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 现，但是血小板计数结果很低，那就有必要怀疑一下结果是否可信，当然，作为病人不一定有这个能力去分析，但是总的来说，检查结果有异常，不一定都是有临床意义，或者可以理解为结果有异常时不一定代表着肯定有什么疾病或有application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 病情变化，有时候太忙，我不一定都会给予详细的解释，可能只是用“这个结果的偏高或偏低没有什么意义”之类的话简单解释。 血常规结果往往包括三部分内容，下面分别解释。 第一部分是关于红细胞的，包括了红细胞计数、血红蛋白值、红细胞压积、平均红细胞体积、平均红细胞血红蛋白量、平均红细胞血红蛋白浓度、网织红细胞比例和绝对值、红细胞分布宽度等等，其中红细胞计数、血红蛋白值、红细胞压积主要时用于判断是否有贫血、是否有红细胞增多。明显升高的不一定都是真性红细胞增多症(一种原发性的骨髓增殖性疾病)，也有可能是继发性的，譬如见于居住高原的、有心肺方面疾病导致长期缺氧的、吸烟嗜好者、大量腹泻等脱水所致血液浓缩等等。三个平均指数(平均红细胞体积、平均红细胞血红蛋白量、平均红细胞血红蛋白浓度)是用于判断贫血原因的，可以先分出是大细胞、小细胞还是正细胞性贫血，然后再进一步有针对性的寻找贫血原因，不至于过度的范围太广的检查。有时候完全没有贫血，这三个指数的偏高偏低不一定有明确的临床意义。红细胞分布宽度应该也是一个判断贫血原因的指标，只是用得比较少。网织红细胞是一种接近成熟的红细胞，正常情况下外周血中很少。在骨髓造血很活血的情况下(尤其是红细胞系)，释放到外周血的网织红细胞可能会增多，譬如溶血性贫血、失血性贫血以application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 及一些营养性贫血有效治疗后。如果骨髓增生程度减低，可能会出现外周血中网织红细胞减少，最典型的例子就是比较严重的再生障碍性贫血，当然，有时候再障不太严重时不一定网织红细胞减低。其实可以看出，网织红细胞也是帮助判断贫血原因的指标之一。 另外需要补充一点，红细胞、血红蛋白和红细胞压积在男女是有不同的正常参考范围的，女性正常范围略低于男 9性，譬如说红细胞正常范围在男性是4-5.5×10/L，女性是 93.5-5×10/L，血红蛋白正常范围在男性是120-160g/L，在女性是110-150g/L。 第二部分是关于白细胞。白细胞是一大类细胞的总称，包括了中性粒细胞、淋巴细胞、单核细胞、嗜酸粒细胞、嗜碱粒细胞，所以往往不应该只是关注白细胞计数。其中中性粒细胞计数比例最高，正常情况下占了50-70%，其次是淋巴细胞，占了20-40%。在血常规检查结果中，不同的白细胞包括了各自的计数和百分比。需要强调一下，看血常规中白细胞结果时，不能只看计数或只看百分比，而是综合分析。经常会有百分比偏高或偏低而实际上没有什么意义，譬如说中性粒细胞本来占了多数，如果由于种种原因导致中性粒细胞减少了，那淋巴细胞百分甚至单核细胞等的百分比就相应升高了，而计数很可能正常，那么这种淋巴细胞、单核细胞比例偏高就没有什么具体意义。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 仪器分析不一定能把各种白细胞分得很清楚，譬如说白血病细胞经常会被分入单核细胞、淋巴细胞之列，所以，当分类计数和比例明显异常时，最好需要结合白细胞手工分类帮助判断。 抽血时状态可能会影响粒细胞结果，譬如饥饿、寒冷、紧张等可能会导致粒细胞增高。 中性粒细胞降低常见于药物因素(譬如化疗药)、再生障碍性贫血、骨髓增生异常综合症、白血病、脾亢、某些病毒感染、严重感染等，增高见于各种感染(尤其是细菌感染)、化学性或免疫性炎症、急性中毒、急性失血、组织损伤坏死、恶性肿瘤、白血病和骨髓增殖性疾病等等。中性粒细胞低于 90.5×10/L(也就是习惯上说的500个/ul)称作为粒细胞缺乏，这种状态下很容易继发感染，尤其是持续粒细胞缺乏的，所以粒细胞明显减低时一定要注意预防感染。 淋巴细胞增多见于生理性增多(譬如婴幼儿)、感染(如病毒感染、百日咳、结核、梅毒等)、急性传染病恢复期、自身免疫性疾病和排异、淋巴细胞白血病等等。淋巴细胞减少见于皮质醇或烷化剂治疗后、辐射损伤、免疫缺陷等。 单核细胞增多常见于病毒、立克次体感染;慢性细菌、螺旋体或寄生虫感染;急性传染病或急性感染恢复期;淋巴瘤、单核细胞白血病等等，减少没有明确的临床意义。 嗜酸细胞增多常见于变态反应性疾病(包括异基因干细application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 胞移植后的移植物抗宿主病)、寄生虫病、肿瘤性疾病(如慢粒、真红、淋巴瘤等)、内分泌疾病(如皮质功能减退)、某些结缔组织病、嗜酸细胞增多症等等。嗜酸细胞减少常见于急性严重感染、应激状态、皮质醇增多或皮质激素治疗后。 嗜碱粒细胞增多常见于骨髓增殖性疾病、慢性溶血、脾切除后、铅中毒等等，慢性粒细胞白血病病人病程中如果出现嗜碱粒细胞明显的进行性的增高，可能提示病情在进展，需要警惕。嗜碱粒细胞减少没有什么临床意义。 第三部分是关于血小板。包括了血小板计数、血小板平均体积和分布宽度，主要是血小板计数，后两者是用于判断血小板数量异常的原因和提示一些血小板功能性疾病，但是很少用。 9关于血小板计数，通常正常参考范围是100~300×10/L，就是通常说的10万~30万/ul，有些医院的仪器设定的参考范围可能有所差别。当检测结果略高于正常范围时，譬如35~40万左右，绝大多数是没有什么临床意义的(尤其是化疗后造血恢复期或者是缺铁性贫血)，别觉得高出好几万很可怕，不需要进一步特殊的检查和采取特殊的措施(一般没有什么危险)，可以过些日子再复查观察，如果继续进行性升高，譬如持续地(半年左右)高于45万以上，需要考虑原发性血小板增多症或其它骨髓增殖性疾病，但是这种疾病毕竟是少数，如果刚发现血小板在45万左右，而且没有其它的骨髓增application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check 殖性疾病的依据，没有必要急着做全面检查，以观察为主，以免过度检查。 检查结果显示血小板明显减少，但是临床上没有任何出血表现的，需要排除假性血小板减少现象，尤其是一种EDTA诱导的血小板聚集导致的血小板假性减少，换一种试管放血标本就能判断出是不是这种情况，通常用于血常规检查的标本是放在EDTA抗凝的试管中的。 血小板计数容易受到外界因素影响，主要是导致血小板计数减低，譬如抽血不顺利、标本放置时间过长或过短(过短的情况不多，最好是在30分钟~2小时之间)、血脂过高、仪器本身因素等。 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image check